Extraction of Broken Flexible Reamer Using Kuntscher Nail Reamer While Performing Femur Nailing: A Case report

Femur nailing is a standard surgical procedure used to treat femur fractures. Complications can arise such as breakage of the flexible reamer within the femoral canal. The case report by Kotian P et al presents a very rarely encountered scenario during a femur nailing procedure where a broken flexible reamer was extracted retrogradely from the femoral canal. The article has been published in ‘Journal of orthopedic trauma and reconstruction.’

This case highlights the importance of proper instrumentation and the adaptability required in orthopedic procedures. Instrument breakage is one of the rare complications faced by surgeons during orthopedic procedures. Preparedness keeping various removal techniques in mind is of utmost importance to come out of such a distressful situation.

A 26 year old male patient presented with a fracture of the right femur following a motor vehicle accident. The patient was scheduled for a femur nailing procedure under general anesthesia. The initial steps of the surgery, including the creation of the entry point and insertion of the guidewire, were uneventful. However, during the insertion of a flexible reamer, it unexpectedly broke inside the femoral canal, leaving a portion of the reamer lodged within the bone.

The surgical team decided to extract the broken reamer to ensure proper placement of the intramedullary nail. Due to the nature of the fracture and the location of the broken reamer, alternative techniques such as fluoroscopic guidance or manual extraction were deemed unsuitable. Instead, a K nail reamer, normally used for canal preparation, was chosen to serve as an extraction tool.

A small lateral incision was made at the fracture site to expose the femoral canal, and the K nail reamer was introduced. Careful maneuvering was required to engage the broken portion of the flexible reamer. Using a combination of rotational and gentle axial movements, the broken fragment was gradually dislodged from the bone. Once the fragment was freed, it was removed from the femoral canal using a sequestrum holding forceps. The extraction site was thoroughly irrigated and confirmed using fluoroscope to look for any remnants in the canal. The patient underwent intramedullary nailing of the femur which went uneventful.

Postoperatively, the patient was placed on a standardized rehabilitation protocol. Follow up examinations and radiographs showed satisfactory alignment and healing of the fracture. The patient experienced no significant complications, such as infection, non union, or limb length discrepancy, during the recovery period. The successful extraction of the broken flexible reamer and subsequent completion of the femur nailing procedure facilitated the patient’s return to pre injury functional status.

Further reading:

Kotian P, Nayak UK, Baranwal S, Shetty V. Extraction of broken incarcerated flexible reamer using Kuntscher nail reamer while performing femur nailing: A technical note. J Orthop Trauma Reconstr 2024;1:41-3.